[Prescription of GLP-1 receptor agonists and iSGLT2 in geriatrics, is there a risk?].

The use of GLP-1 receptor agonists and iSGLT2 is becoming increasingly common, in line with new guidelines issued by the learned societies of cardiology, nephrology and diabetology. However, the enthusiasm aroused by these new drugs needs to be tempered and their use in the very elderly and/or frail needs to be carefully considered by the lack of scientific studies in this population category, , and their prescription requires a comprehensive geriatric assessment before initiating this type of treatment.

Long-Term Mortality in Very Old Survivors of COVID-19.

Objectives: This report aimed to describe mortality at 18 months in older survivors of the first wave of COVID-19.

Design: Observational cohort study.

Setting And Participants: Patients aged ≥65 years hospitalized for COVID-19 in the acute geriatric wards of 2 centers.

[An assessment of an orhthogeriatrics unit 5 years after its creation].

On January 1st, 2018, we established an orthogeriatrics (OG) unit for patients aged ≥ 70 years old with hip fracture, based on a purely geriatric management 24-hours post-operation. In this article we discuss the results of the implemented measures (geriatric follow-up with standardized protocols) on mortality after 6 weeks, operative delay, and complications. Among the 607 treated patients, the mortality rate was 6.

Mortality in COVID-19 older patients hospitalized in a geriatric ward: Is obesity protective?

Backgrounds: To investigate the relationship between obesity and 30-day mortality in a cohort of older hospitalized COVID-19 inpatients.

Methods: Included patients were aged 70 years or more; hospitalized in acute geriatric wards between March and December 2020; with a positive PCR for COVID-19; not candidate to intensive care unit admission. Clinical data were collected from patients electronic medical records.

[Geriatric syndromes and polypharmacy: to prescribe or to proscribe that is the question].

How to apply treatment recommendations from various knowledgeable specialist societies concerning the very complex patient? Within a population weakened by the cumulative effect of comorbidities, loss of autonomy aggravated by geriatric syndromes and biological changes linked to aging which interact with the pharmacokinetics and pharmacodynamics of drugs, there is fertile soil for the advent of adverse conditions linked to simultaneously prescribing multiple treatments. Our aim is to analyze various clinical reasoning tools permitting an appropriate drug prescription while considering the state of health, life expectancy and time to benefit with the aim of reducing iatrogenesis.

[Treatment of the frail older diabetic : less is so much more].

Improving glycaemia level is helpful to the clinician in diabetes management. Elderly diabetics make up a group that is non-homogeneous and with a very varied health status, whose treatment must be adjusted to take into account comorbidities, degree of frailty and both functional and mental disability, in addition to their life expectancy and personal preferences. Thus, the target of treatment should be defined along three categories of patients: robust, vulnerable and dependent.

[Too old or too frail for intensive care?].

What are the criteria for admitting an elderly polymorbid patient to intensive care ? The multidimensional geriatric evaluation is a tool to screen for geriatric syndromes, with the division of elderly patients into 3 categories: robust, vulnerable and dependent. Targeting certain co-morbidities such as cognitive disorders, delirium, frailty, polymedication and malnutrition, allows clinicians to estimate the risks of mortality and functional and cognitive handicaps during a stay in intensive care. Based on a review of the literature, this article offers some guidelines for triage of older patients for admission to intensive care, using an ethical, multidisciplinary approach that takes into account the patient's fears and preferences.

[Anticoagulation in vulnerable elderly patients with atrial fibrillation : risks and benefits].

Atrial fibrillation is a common cardiac disease of aging. The risk of stroke and bad prognosis increase with age and atrial fibrillation. Compared with younger people, elderly people have higher risks for both thrombosis and bleeding.

[Geriatrician and orthopedist : happy wedding ?].

Proximal femur fractures in the elderly are still a major event in the functional trajectory of patients. In order to optimize their care, a pilot orthogeriatric unit was created in 2018 at the Valais Hospital. This innovative unit, managed by the internist-geriatrician within the orthopedic department, allows the early and standardized management of geriatric syndromes and postoperative complications.

[Fracture in older diabetic, harm of intensive diabetic therapy ?].

Does inappropriate treatment contribute to the risk of falls and fractures in older diabetic patients ? Among 2205 diabetics hospitalized in a geriatric ward, this retrospective study analyses the follow-up of the group with a fracture (12 %) according to the glycated hemoglobin (HbA1c) and the recommended targets. In our collective where only 4 % are healthy (50 % are vulnerable, 46 % are frail), the average value of HbA1c is 6.9 %.

[Prevention in older age : key factors].

The extended life expectancy questions the quality of life of these additional years: with or without disability ? A review of the literature gives us some tips on preventive measures to maintain good health at an advanced age. Engaging in regular and moderate physical activity (such as walking) offers a range of health benefits, including reduced risk of all-cause mortality, lower risk for various diseases (ischemic stroke, ischemic heart disease, diabetes, breast and colon cancer), prevention of falls and functional decline in seniors living at home. Maintaining a healthy lifestyle (non-smoking, low alcohol consumption, adequate nutrition) as well as up-to-date immunization status and vitamin D supplementation in the deficient or vulnerable population, are factors that contribute to a better health in the last years of life.

[Capgras delusion and Alzheimer disease].

Capgras delusion is classified with the misidentification syndromes. In dementia it associates cognitive deficiency of memory and facial recognition (prosopoagnosia) with delirious idea of substitution by a double. The first reported case in the paper describes the important affective and comportmental reactions due to the identification of a double perceived as an imposter, affecting both the suffering person and his family.

[Hypertension, diabetes, hyperlipidemia : what are the treatment goals for the elderly ?].

Will my patient actually benefit from the medication that I've prescribed? Faced with an elderly, frail patient, the family doctor is often confronted by this dilemma. This article reviews the evidence that can assist clinicians in determining the best approach to treating diabetes, hypertension and hyperlipidemia in elderly patients, by defining treatment goals specific to each patients' functional and cognitive capacities. Avoiding hypoglycemia and hypotension, with all of their consequences, must remain the highest priority driving objectives for optimal management of diabetes and hypertension in the geriatric population.

[Doctor, physical activity at my age ?].

Engaging in regular and appropriate physical activity confers health benefits at any age. For seniors, swapping the role of « sedentary » for « someone who's on the move » offers much more substantial benefits than any medication, and notably even starting at a dose of 10-15 minutes per day ! Any physician who cares for elderly patients must pursue the objective of encouraging physical activity that is integrated into daily life (e.g.

[From thiamine deficiency to Wernicke encephalopathy, unknown pathology].

The thiamine deficiency and its clinical consequences, especially the Wernicke encephalopathy, are still often not diagnosed. The etiologies are numerous, but the most frequent is the alcohol dependence. The diagnostic is mainly clinical and the treatment must be started as soon as possible by substituting the thiamine with intravenous injection.

[Diabetes: glycemic targets and over-treatment in older patients].

Diabetic glycemic targets in older patients must reflect their preferences, clinical status and life expectancy. The presence of multiple comorbidities as well as functional or cognitive impairment are better predictors than age alone of both limited life expectancy and reduced benefit of intensive treatment. For most of these patients, the harms of intensive diabetes therapy outweigh the benefits.

[Orthogeriatric unit: a marriage of convenience between orthopedic surgeon and geriatrician?].

Hip fracture in the elderly can be associated with dramatic issues like death in the year or severe handicap requiring admission in a nursing home. Implementation of a close cooperation between orthopaedic surgeon and geriatrician materialize in the creation of unit, known as orthogeriatric unit where the roles of each member are precisely defined from admission to discharge, with coordinated care protocols and standardized orders. Benefits of the orthogeriatric ward are clarified in this paper, referring to literature, with description of an improvement of functional score after 3 months, reduction of in-hospital mortality and post-operative complications.

[Amyotrophic lateral sclerosis also threatens the octogenarian].

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, incurable, mostly declared near the age of sixty-seventy, but more rarely for the older individuals. Because presenting symptoms are non specific (muscle weakness, functional decline, loss of ambulation, dyspnea, dysphagia), diagnosis in early stages may be difficult and delayed, particularly on polymorbid older patients. Symptomatic management is the mainstay of treatment for ALS; care in multidisciplinary team, with maximal psychologic support, is associated with enhanced quality of life.

[Various features of diabetes in the elderly].

Diabetes mellitus, a common condition in older persons, is caused by a complex interaction of genetic and environmental factors. Treatment objectives in older diabetic patient will be based on an individualized approach, the target goals varying with life-limiting comorbid illness, cognitive or functional impairments. Appropriate therapeutic goals are to avoid symptomatic hyperglycemic episodes and acute metabolic decompensation, as well as severe hypoglycemia in frail patients, while nutritional restriction should be minimized to prevent these patients' quality of life.